New York End-of-Life Agency Allows Refusal of Food and Water Directive

Recently, the board for End Of Life Choices New York approved an aggressive new document that would allow individuals to stipulate in advance that they may refuse food and water should they develop dementia at some point. The goal of the directive is to allow individuals to speed up their death in late-stage dementia, if they so choose.

Despite being considered a terminal illness, states that already have end of life directives in place do not have laws that cover the condition, putting the new policy into uncharted ethical waters that have not been explored. The move comes as patients across New York and the rest of the country seek alternative options to address the very real possibility that they may become incapacitated with a severely debilitating condition.

The new document would allow patients one of two options should they find themselves in an assisted living situation with dementia. The first would allow patients to accept so-called comfort feeding by providing oral food and water if they patient appears willing to accept the nourishment. The second, would stipulate that the patient would receive no food or water, even if he or she appears to accept the feedings during the final stages of dementia.

Patients may only invoke either of the two options if they have drafted their end of life care document stipulating their choice and a doctor diagnoses the individual with moderate or severe dementia, defined as Stages 6 or 7 of a widely used test known as the Functional Assessment Staging Tool (FAST). During states 6 or 7 of dementia, patients are considered unable to make healthcare decisions for themselves.

On the one hand, supporters of the document believe it the strongest effort to date to allow people who want to avoid the ravages of advanced dementia to make their final wishes known while they still have the ability to do so. On the other hand, critics believe the policy of withdrawing nourishment from extremely vulnerable members of society constitutes a disturbing initiative.

For a number of years now, states like New York have allowed patients to draft end of life directive that allow patients to dictate the type of care they wish to receive in terminal situations where they cannot decide for themselves. This may include not wanting to be resuscitated or kept on life support, such as a ventilator or feeding tube, when they are at the end of their life.